Interdisciplinary Approach to Improved Safety for Patient-Owned Noninvasive Ventilation Devices in the Hospital

Background:

The prevalence of obstructive sleep apnea (OSA) now afflicts at least 25 million adults in the U.S., according to the National Healthy Sleep Awareness Project1. Many of which are receiving NIV therapy at home and frequently request permission to use their own equipment during their hospital stay. Historically it presented a bigger challenge if that permission weren't granted, because the clinical team had a difficult time determining the patient's home NIV settings that could be applied to hospital owned equipment. The development of devices that provide APAP (auto-titrating) NIV support have been critical to solving this problem. Several studies have shown that APAP is as efficient as conventional CPAP in correcting breathing disorders and cognitive impairment in sleep apnea/hypopnea syndrome2. In 2016 two safety reports were submitted as a result of patient owned NIV equipment failure. Clinical staff's lack of familiarity with various devices and no clear process for intake of patient owned equipment put both the patient and hospital at risk for safety events.

Methods:

A team of RNs, RRTs, and biomed technicians was established to develop a process to ensure that any patient requesting the use of their own NIV equipment could be properly checked in and there was an alternative procedure for conditions of failure. The EMR was utilized to support the new policy that required, upon MD order for NIV, that nursing have a waiver signed by the patient validating knowledge of device operation, respiratory would perform a visual inspection prior to use and then send notification to clinical engineering to perform an electrical safety test. If there was a failure in any of these steps then the device is removed from service and the MD order set permits the therapist to place the patient on APAP.

Results:

Since implementation in Sept 2016 there have been no safety reports as a result of patient owned equipment failure that passed inspection. Accurate reporting started in FY18. Since that time, RTs have inspected 917 devices with a pass rate of 98% (n=903 passed, n=14 failed). All failures resulted in the patient being placed on hospital owned APAP.

Conclusions:

Implementation of a procedure with the support of an EMR provides a consistent process to effectively mitigate risk of device failure and/or clinical staff's inability to troubleshoot equipment in which they've received no training. Using an interdisciplinary team effectively covers multiple steps in the process and improves safety.

Patient Owned NIV Inspections